Foundations of CMR: Level 1 Virtual Course-SESSION 4: CMR IN CARDIOMYOPATHY

Video Transcription

Video Summary

This video transcript covers a cardiomyopathy imaging session focused on how cardiac MRI helps diagnose, classify, and risk-stratify multiple heart muscle diseases.<br /><br />Key topics included myocarditis, arrhythmogenic cardiomyopathy (ACM), hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), cardiac amyloidosis, and iron overload cardiomyopathy.<br /><br />For myocarditis, speakers emphasized that preserved ejection fraction is reassuring and often means no steroids are needed. Follow-up can be done with T1/T2 mapping when inflammation is being monitored. PET and biopsy were discussed as complementary tools, especially in sarcoid and unclear cases. Scar quantification was described as mainly semi-quantitative in routine practice.<br /><br />For ACM, three cases illustrated right-dominant, left-dominant, and biventricular disease. The panel highlighted the revised criteria, the importance of ECG, LGE patterns, family history, and genetic testing, especially when myocarditis-like presentations recur. Ring-like or extensive subepicardial scar patterns were linked to higher risk and DSP mutations.<br /><br />For HCM, MRI was shown to be essential for measuring wall thickness, identifying LVOT obstruction, systolic anterior motion, atrial enlargement, apical aneurysm, and LGE. LGE burden, especially when ≥15%, was presented as an important sudden death risk marker.<br /><br />DCM discussion focused on heterogeneity and the prognostic value of scar. Septal LGE and ring-like patterns were emphasized as high risk, while “excessive trabeculation” was preferred over “LV non-compaction.”<br /><br />Amyloidosis imaging showed characteristic diffuse subendocardial LGE, abnormal nulling, and the role of T1 mapping/ECV. Iron overload cardiomyopathy was diagnosed using very low myocardial T1 and T2* values, with dark liver signal suggesting systemic iron deposition.

Keywords

cardiac MRI

cardiomyopathy

myocarditis

arrhythmogenic cardiomyopathy

hypertrophic cardiomyopathy

dilated cardiomyopathy

cardiac amyloidosis

iron overload cardiomyopathy

T1 mapping

T2 mapping

late gadolinium enhancement

risk stratification

genetic testing

LGE burden

myocardial scar